Comparison of Nutritional Status and Inflammational Markers in DM and nonDM Hemodialysis Patients

Kim, Suan; Sohn, Cheongmin; Chae, Dong Wan

Abstract

Protein-calorie malnutrition is common in maintenance dialysis patients. Indeed, diabetic patients with chronic renal failure are considered to be at increased risk of malnutrition. The aim of this study was to compare the nutritional status and markers of inflammation of hemodialysis patients with and without type 2 diabetes. We compared nutritional parameters and C-reactive protein (CRP) as a marker of inflammation in 30 type 2 diabetic patients and age-matched 30 non-diabetic patients with hemodialysis. Serum albumin was significantly lower in patients with type 2 diabetes (3.45 +/- 0.43 g/dL) than in non-diabetic patients (3.64 +/- 0.36 g/dL) (p < 0.05). In contrast, the concentration of serum CRP was significantly higher in type 2 diabetes (1.42 +/- 1.8 mg/dL) (p < 0.05). There were significant negative-relationships between serum albumin and CRP level in both diabetic (r = -0.553, p < 0.01) and non-diabetic (r = -0.579, p < 0.01) patients. In diabetic patients, serum albumin level was significantly correlated with hemoglobin (r = 0.488, p < 0.01) and hematocrit (r = 0.386, p < 0.01). Diabetic patients as compared to non-diabetic patients showed a significant (p < 0.01) increased serum triglyceride (TG) (153.1 +/- 80.1 mg/dL vs 101.6 +/- 62.4 mg/dL) and decreased serum HDL cholesterol (36.89 +/- 13.48mg/dL vs 47.00 +/- 14.02 mg/dL, P < 0.05). There were significant correlations in the intake of calorie and serum albumin levels in both diabetic (r = 0.438, p < 0.05) and non-diabetic (r = 0.527, p < 0.05) patients. Serum CRP level was negatively correlated with calorie (r = -0.468, p < 0.05), protein (r = -0.520, p < 0.01) and fat intakes (r = -0.403, p < 0.05) in diabetic patients and calorie (r = -0.534, p < 0.05) and protein intakes (r = -0.559, p < 0.05) in non-diabetic patients. The prevalence of protein malnutrition and the risk factors of cardiovascular disease were significantly higher in type 2 diabetic patients than in non-diabetic hemodialysis patients. Thus, we can suggest that the higher comorbidity and mortality rate in diabetic hemodialysis patients are partially explained by malnutrition and inflammation.